Maximizing the Shadowing Experience: A Guidance Document

Abstract

Job shadowing is an excellent way to learn more about the pharmacy profession. The shadowing individuals gain a greater sense of the role pharmacists play in the health care team and are exposed to the variety of roles that are filled by pharmacists. Job shadowing is also an important way for pharmacists to demonstrate the value of the profession and recruit talented individuals to their institution. However, there are several important considerations to ensure that the shadowing experience is beneficial for the individual, is a positive experience for the sponsor, and is compliant with the host institution's policies and procedures. The goal of this article is to prepare a potential host site for developing and maintaining a successful job shadow experience.

Job shadowing is a common method for individuals to learn about the pharmacy profession as a career and the pharmacist's role in the delivery of health care. Pharmacies may frequently receive requests to host interested pre-pharmacy or pharmacy students, but they may not have a process in place to ensure a successful shadowing experience. Shadowing should be a positive experience for the host as well as the shadow participant; however, the pharmacist host must also ensure that the shadowing experience does not negatively impact patient care or violate patients' trust and privacy.

Little guidance has been published regarding pharmacy shadowing experiences, and there are limited applicable examples from other health professions. The Association of American Medical Colleges adopted guidelines in 2013 that provide baseline standards and responsibilities for the shadowing pre-medical student and physician host. ¹ Kitsis and Goldsammler provided a review of 13 studies evaluating different physician shadowing experiences. ² Nurse shadowing programs have been designed to help recruit nursing faculty and future nurses.^3,4 The University of Michigan and the Agency for Healthcare Research and Quality developed shadowing programs to build better interprofessional collaborations.^5,6 Health care institutions often develop shadowing guidelines and processes, examples of which may be found on institutional Web sites.^7–15 The institutions' shadowing guidelines include a variety of requirements, expectations, and suggestions for a successful shadowing experience. The resources from physician, nursing, and institution shadowing experiences are helpful examples; however, there is a lack of published information on pharmacy shadowing experiences. The intent of this article is to provide an overview of the considerations that should be taken into account in order to develop a successful pharmacy shadowing program.

Benefits of Shadowing

The shadowing experience can take many forms. Pharmacy students are encouraged to shadow as they get closer to their introductory pharmacy practice experience (IPPE) and advanced pharmacy practice experience (APPE) rotations. High school students shadow to see what an actual hospital pharmacy work environment is like. Likewise, many colleges of pharmacy encourage pre-pharmacy students to shadow or volunteer in pharmacies to confirm that pharmacy is the career for them. Individuals who are considering a career change also may want to get a better sense of what a career in pharmacy is about by seeing it first-hand.

Shadowing is different than volunteering. Pharmacy volunteers provide unpaid support and usually assist with the completion of nonclinical tasks that the pharmacy may not have the time or resources to address. Volunteer tasks may or may not involve any patient contact and may involve tasks that are not meant to provide a direct learning opportunity. Volunteering allows students to indirectly observe the interactions among the different members of the health care team and to demonstrate their commitment to service over time.

Shadowing is a more passive experience. Shadowing individuals play the role of observers. By accompanying pharmacy staff while they perform their usual day-to-day responsibilities, individuals obtain an introduction to the profession of pharmacy and gain a better understanding of what a health career might be like within that specific health care setting. They are able to directly observe the interactions of pharmacy staff with other members of the pharmacy department, other health care providers, and patients. The shadowing students do not provide any direct patient care or engage in any activity that is considered the practice of pharmacy, and they are always under the direct supervision of a member of the pharmacy staff.

Students benefit from shadowing because they are able to observe the actual activities that occur in their potential career choice. There are, however, benefits to the organization as well. Pharmacy staff are able to observe future potential job candidates outside of the interview process. More importantly, however, the organization can demonstrate why it would be a good choice for the shadowing student if he or she should apply for a position in the future. The shadowing experience provides insight into the organization's mission and values. It shows a future potential candidate the organization's approach to doing business in terms of ethics, providing patient care, and focusing on quality. In times of manpower shortages, this could be a powerful recruiting tool.

Responding to Shadowing Requests

There are numerous items the host site needs to evaluate when planning for or reacting to a request to host a shadowing experience. First, the site needs to determine whether the organization is suited to host shadowing experiences. The pharmacy may reach out to other departments in which students are commonly trained to see how these situations are handled. The site's human resources department may already have policies for shadowing that will have to be followed, such as the need for vaccinations and Health Insurance Portability and Accountability Act (HIPAA) training. Other departments may be involved in making these decisions or giving guidance (eg, the hospital's privacy office or visitor programs department). A number of environmental and human resource elements should be taken into account when a pharmacy department considers a shadowing request (see Appendix).

Approval from the leadership of the organization and the pharmacy department must be obtained before accepting shadowing students. If the pharmacy is not equipped to handle the shadowing students, the experience could result in a negative impression about the profession of pharmacy and/or have a negative impact on the health care organization's future recruiting efforts. If more than one person is involved in deciding whether a request is appropriate, efforts must be coordinated so that there is consistency in the criteria used to determine whether a person can shadow and that there will be no problems with scheduling overlaps.

Before allowing students to shadow in the pharmacy department, it is important to assess the overall morale of the department. Are staff enthusiastic about the profession for pharmacy and willing to share their passion for their profession with others? If there have been recent changes, are employees comfortable explaining these to the observer and expressing their buy-in? The persons shadowing should not necessarily be shielded from the complexities and challenges in the department, but the issues should be described to them in a non-biased manner.

What students should the department host? It may be easier to implement a shadowing program if there is already a relationship with a college's introductory and advanced pharmacy practice experiences (IPPEs and APPEs). Some requests for shadowing experiences may come from schools that do not have a relationship with the hosting organization. The time involved to develop appropriate contracts and take care of other paperwork must also be taken into account when determining the value of agreeing to these requests versus the ones from colleges with existing relationships.

Requests from high school or college students who are not in pharmacy or health care fields may also be received. The particulars of these hosting experiences may be more difficult to determine, since the requirements of the shadow participants may vary greatly. However, once an arrangement has been made, it will be easier to continue to host other nonpharmacy students from the same school, because the groundwork has already been established.

Structuring a Shadowing Experience

Once the decision is made to implement a shadowing program, the next step is to develop the structure to support the program. Written guidelines should detail preceptor responsibilities and the boundaries of what the shadowing students can and cannot do. A department may determine that it is most effective to schedule specific dates and times for shadowing so as to maximize certain experiences (eg, patient care rounds/weekly conferences) and to minimize disruption of routine activities.

If pharmacy students from specific schools are requesting observerships in areas outside the formal curriculum (eg, IPPE/APPE), discussion with representatives from the school and pharmacy department to determine a template of standard activities might make scheduling easier. If a template is used, the option of changing it based on a student's previous experience and interests should be explored, as this can address the individual student's motivations for shadowing. Individuals who request a shadowing experience can be asked to complete a written application to more specifically customize their time at the institution.

Decisions also must be made about who will coordinate the experience for the host organization, including scheduling activities and ensuring that these activities are meaningful. Are there certain times or number of hours that would be most beneficial and least disruptive to the department in which the activities are taking place? There are some areas, while possibly of interest, in which it would not be appropriate to allow shadowing.

If the shadow request originates from a school or organization, is there a project that needs to be completed as part of the experience? If so, a list of projects could be developed between the sponsoring organization and the host department. The publication or presentation of these projects could benefit both parties and provide valuable visibility.

When a shadowing experience is developed, patient privacy is also an important issue to consider. Patient privacy (eg, HIPAA) guidelines must be reviewed and strictly adhered to, based on institutional requirements. Written guidelines should detail how and when students are able to observe patient-health care interactions and how students are to be introduced to patients, if this activity is to be offered. Not all patients will be comfortable with students listening to their conversations with health care professionals, and specific authorization by the patients may be required if observers are to be involved in patient care activities.

The involvement of pharmacy personnel who are interested in teaching and mentoring is vital to a successful shadowing experience. They are “ambassadors” for the department and pharmacy experiences. The attitude and behaviors of the hosts should always be courteous and professional; the shadowing experience may generate interest in future employment or rotations with the institution or in pharmacy in general. Hosting staff may need specific training in order to be appropriate mentors and role models. Training should be developed from a human resources perspective as well as that of the department; the hosting employees should be knowledgeable about pharmacy services, issues regarding patient privacy, and any limits the institution places upon those who are shadowing.

If the shadowing student will be involved in a number of different areas, timely communication with other staff about the role of the observer is important. E-mails to staff or announcements at an area meeting may be effective. The involvement and support of other staff members, depending on the specific situation, is important for making a positive impression on the observer.

Before the actual shadowing event, the host institution should communicate the specifics of when and where the observer should arrive, mostly likely via e-mail (see Appendix). The person shadowing may be required to bring appropriate immunization records and documentation to prove his/her identity (government-issued identification). These documents may be shared with other departments within the hospital.

Although much of the information that the student will need for the experience will have been developed when the program was structured, additional information specific to the event can be inserted into a guidance document (eg, orientation packet) to be reviewed with the student on arrival. This may include an overview of the site, the schedule, and appropriate policies and procedures (eg, HIPAA, guidelines about patient interactions, photography restrictions). Before proceeding to the area of observation, the host can review the logistics for the period of shadowing, including where to report each day if the experience is for more than one day, provide an overview of the host organization and department, assist with completion of paperwork, and make introductions to others involved in the experience. With these issues reviewed, the shadowing experience can proceed with a sound foundation.

During the actual observation period, the hosting pharmacist should solicit periodic feedback to determine how the student is doing, answer questions, and adjust, if possible, his or her approach so that the student will get a personalized experience. Not all processes that are observed may be valued, but the experience will give the shadowing student a real-life glimpse into day-to-day activities.

At the end of the shadowing experience, an evaluation (written or oral debriefing) can be an effective way for an organization to improve subsequent observerships. Also, the student may ask the host for a recommendation or other letter of support. In that case, information from the visit should be recorded and kept on file to assist the host in responding to the student's request. The school or other sponsor may have an evaluation document template already available.

As part of an ongoing process, the host organization should periodically review the program to determine whether the effort is worth the return. Feedback from the hosting individuals, as well as staff and department leadership, should be solicited. To maintain a high-quality experience, precepting skills should continue to be developed in staff who participate in the shadowing experience. Hosts who can listen and adapt to the needs of the shadowing students help create valuable experiences.

Conclusion

The pharmacy shadowing experience should be valuable for both the observer and the host. Available literature indicates that shadowing experiences are usually arranged based on guidelines created by individual health care and/or academic institutions. Some are structured more informally than others. However, a number of issues need to be taken into consideration when creating the shadowing experience. Confidentiality of patient issues and other protected health information is paramount. The environment for shadowing, the background and suitability of the shadowing participant, and the preparations made by the institution and the specific sponsor for the visit are all vital to the success of the experience for all involved. Reflection about and a review of the process should be conducted periodically in order to ascertain whether it still has value.

Shadowing should be conducted so that it provides a benefit to the observer, while not being an undue burden on the host or sponsor. As we introduce someone to our field, our colleagues, our workplace and perhaps our patients, we are making an impression that can last a lifetime. With the logistics taken care of, the experience can be a “win” for the student as well as for the host.

Appendix. Creating a Pharmacy Shadowing Experience

1. Assess Environmental Conduciveness for Shadowing

• •Insure sufficient resources.
  • ○Oversight and supervision capacity
  • ○Employees with oversight interest

• •Determine relevant institutional policies and procedures.
  • ○Existing process in institution or other departments
  • ○Relevant policies and procedures
  • ○Input of Human Resources / Volunteer Office / Visitor Program departments

• •Evaluate human resources requirements.
  • ○Documentation of required training and health prevention efforts (eg, HIPAA, tuberculosis testing, vaccinations, basic life support) and timing of when received (eg, prior to arrival for experience)
  • ○Security considerations related to access (eg, hospital identification/name badge, physical access to specific areas)
  • ○Minimum age requirements for “shadowers”

• •Determine desired focus of shadowing experiences based upon requests likely to be received.
  • ○Seeking general experience or community service
  • ○Exploring a career in the health professions – experiences beyond pharmacy
  • ○Pursuing a career in pharmacy – limited experiences in department
  • ○Enrolled in pharmacy school – focused experiences in department

• •Evaluate the necessary structure based upon the learner's likely needs.
  • ○Career exploration – general exposure to profession and hospital operations
  • ○Pharmacy career refinement – specific goals or objectives for the shadowing experience as defined by a formal educational unit (eg, course or program of study)
  • ○Self-professed student's desired scope of experiences and information
  • ○Number of contact hours necessary to achieve learner's needs

2. Develop Structure to Support Shadowing

• •Align employees with support roles and responsibilities.
  • ○Evaluate shadowing requests for suitability, capacity, and timing
  • ○Match students with interest areas and preceptors
  • ○Assign routine vs customized activities for each student

• •Inform stakeholders of key program features.
  • ○Student's host or preceptor
    • □Preceptor responsibilities
    • □Potential scope of student activities
    • □Evaluation process, if applicable
  • ○Other stakeholders
    • □Benefit of program to department
    • □Roles of key individuals in shadowing
    • □Impact of employee actions and attitudes on visiting students

• •Determine information to share with each student prior to activity.
  • ○Departmental information, including dress code, items to bring (student identification badge, human resource documentation, educational program forms), prohibited items (eg, valuables)
  • ○Security and site access considerations
  • ○Operational guidance documents (eg, department description, map, organizational chart, telephone or e-mail directories)
  • ○Documentation of training as required by human resources
  • ○Key locations to demonstrate to student during an orientation tour
  • ○Location for student to store personal belongings
  • ○Parking or transportation information
  • ○Directions to hospital or practice site

3. Respond to Specific Requests for Shadowing

• •Ensure sufficient capacity to host student during requested period of time.
  • ○Mentors or preceptors available in area of student's interest
  • ○Sufficient capacity to accommodate learners if other trainees already on site
  • ○Reconcile student interests with departmental features to insure alignment

• •Insert experience-specific information in guidance packet provided to student prior to arrival.
  • ○Student details (eg, name, interests, dates of shadowing experience)
  • ○Dates and times of shadowing experience
  • ○Directions to location for reporting upon arrival at practice site
  • ○Contact information for experience coordinator
  • ○Host's business card

• •Identify key personnel to conduct activities.
  • ○Greetings upon student arrival
  • ○Introduction to departmental staff
  • ○Tour of department
  • ○Location for storing personal items
  • ○Security and access considerations
  • ○Daily or activity-based oversight
  • ○Periodic feedback from student (eg, alignment of activities with interests, desired experiences)

• •Guide student regarding expectations, policies, and schedule.